In-depth: Asia: Facing the HIV/AIDS challenge
Eam Vanndy, a male commercial sex worker in the Cambodian capital, Phnom Penh
JOHANNESBURG, 5 January 2007 (IRIN) - South East Asia has the largest number of people living with HIV after Africa, and its share of the global epidemic is growing - an estimated 8.6 million people in the region were living with the virus in 2006, with the epidemic expanding faster than anywhere else in the world.
Because of the size of the region's population, relatively modest HIV prevalence can translate into millions of cases. Just three countries - Cambodia, Myanmar and Thailand - have an infection rate of over 1 percent, but UNAIDS has urged national authorities to avoid complacency, and act now to prevent a larger emergency.
National epidemics are centred on key vulnerable groups: sex workers and their clients, injecting drug users, men who have sex with men, and mobile population groups. UNAIDS warned in a 2005 report, 'The scaled-up response to AIDS in Asia and the Pacific', that "unless determined action is taken now", the virus could move into the general population.
The agency points to Indonesia as an example of the potential of HIV infection to accelerate rapidly from an extremely low prevalence base. In 1998, prevalence was 0.1 percent, even among female sex workers; a year later, surveys were detecting a jump in infection rates - as high as 6 percent in some sentinel sites.
"Because sex workers and injecting drug users can provide HIV with a 'bridge' to other populations via their sexual partners, Indonesia now confronts the real risk of a major expansion of the epidemic," the UNAIDS report commented.
Frequent natural disasters in South East Asia cause large population displacements, deepening poverty and substantially increasing the risk of contracting the virus. Institutionalised gender inequality also means that, across the region, women and girls are at growing risk of infection, with marriage far from being a guarantee of safety from HIV.
This in-depth examination of the epidemic in the region looks at responses by governments and civil society in four countries: Laos, Myanmar, Cambodia and Indonesia.
In Laos, the uphill struggle to keep the lid on infection amid rapid social and cultural changes is mapped, while in Myanmar, where the authorities have belatedly taken up the AIDS challenge, the complication of low levels of international funding is highlighted. Cambodia's hidden world of men who have sex with men in conservative Khmer society is explored, as is the burden faced by housewives infected by their husbands. Finally, the HIV/AIDS challenge in post-Tsunami Indonesia is given a closer look.